The Diagnostic Importance of Recombinant Allergen IgE Testing in Patients with Hymenoptera Venom Allergy: Comparison of Two Methods

Dragana Jovanovic; Aleksandra Peric-Popadic; Sladjana Andrejevic; Maja Stojanovic; Branka  Bonaci-Nikolic

doi:10.18502/ijaai.v20i4.6951

Dragana Jovanovic Clinic of Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
Aleksandra Peric-Popadic Clinic of Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
Sladjana Andrejevic Clinic of Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
Maja Stojanovic Clinic of Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia
Branka Bonaci-Nikolic Clinic of Allergy and Immunology, University Clinical Centre of Serbia, Belgrade, Serbia

DOI: https://doi.org/10.18502/ijaai.v20i4.6951

Keywords: Anaphylaxis; Hymenoptera; Honeybee venoms; Immunoblotting; Wasp venoms

Abstract

Adults with systemic anaphylactic reactions (SAR) to insect sting show often multiple-positivity of serum-specific IgE (sIgE) to Hymenoptera venoms. Unnecessary long-lasting venom-specific immunotherapies (VIT) in false-positive patients increase the risk of recurrent SAR. This report aims to analyze the diagnostic importance of recombinant allergen IgE testing in patients with SAR to Hymenoptera sting.
In 82 patients we measured sIgE to honeybee venom (HBV), wasp venom (WV) and hornet venom (HV) extracts, recombinant phospholipase A2 from HBV (sIgE-rApi m1), recombinant antigen 5 from WV (sIgE-rVes v5), and cross-reactive carbohydrate determinants-CCD-bromelain by ImmunoCAP. We analyzed the correlation of ImmunoCAP and Immunoblot for HBV and WV extracts, rApi m1, and rVes v5 in 39/82 patients. According to the history of the culprit insect, we compared sensitivity and specificity between the two methods.
The severity of the SAR does not depend on the sIgE level to venom extracts and recombinant allergens. Fifty-one percent of the patients had a multiple-positivity to HBV/WV or HBV/WV/HV extracts. Severe SAR and CCD-sIgE were more frequent in multiple-positive than single-positive patients. CCD-sIgE were more frequent in HBV allergic patients than WV and HV allergic patients. There was a significant correlation between levels of sIgE to venom extracts and recombinant allergens measured by ImmunoCAP and Immunoblot. ImmunoCAP has higher sensitivity and specificity than Immunoblot for diagnosis of SAR to Hymenoptera venoms.
IgE testing to recombinant CCD-free allergens is necessary for the adequate selection of long-lasting VIT, especially in patients with multiple sensitivities to venom extracts.